Children with croup who are ill enough to require hospital care should be given a single systemic dose of a corticosteroid, says Drug and Therapeutics Bulletin (2000;38:3). Corticosteroids are used in croup to help reduce airway inflammation and oedema.
The bulletin says that data from clinical trials show that dexamethasone (oral) and budesonide (nebulised) are similarly effective in reducing the severity of croup. However, no benefit has been shown with corticosteroids given by metered dose inhaler. While there are no published data on treating croup with corticosteroids in general practice, evidence for the efficacy of single doses in hospital outpatient units suggests that such treatment could be given by general paractitioners prior to the patient going to hospital, it says. The bulletin suggests that dexamethasone suspension or tablets are cheaper and may be more practical to use than corticosteroids that are given by injection or nebuliser. There is insufficient data to support the use of soluble prednisolone tablets in croup, it comments.